Analyzing Crohn’s Disease and Ulcerative Colitis

Analyzing Crohn’s Disease and Ulcerative Colitis

There are many unanswered questions and concerns about Crohn’s disease and ulcerative colitis, two forms of inflammatory bowel disease (IBD), especially if someone close to you has been diagnosed. Let us look and identify the symptoms, treatments and tips for living with these diseases.

Crohn’s disease and ulcerative colitis are chronic disease conditions affecting the lining of the gastrointestinal tract. Both Crohn’s disease and ulcerative colitis are caused by chronic inflammation in the lining of the bowel mucosa, constituting major disease entities of IBD. Crohn’s disease can manifest anywhere within the digestive tract and ulcerative colitis is typically localized in the colon (large intestine) and rectum (end of the large intestine).

According to Centers for Disease Control and Prevention, there has been a significant increase in the disease burden from almost 1 to 1.3 percent during the past 15 years with about 3 million people currently suffering from IBD. Approximately 70 to 150 new cases are diagnosed per 100,000 people. Historically, males and females are equally affected, but recent trends show males are slightly more affected by ulcerative colitis. Both Crohn’s disease and ulcerative colitis are more common in Caucasians, compared to African American and Hispanic populations.

Causes and risk factors:
The exact cause of both Crohn’s disease and ulcerative colitis is unclear, but several risk factors have been identified as significant. In IBD, the patient’s immune system activates inappropriately against foreign triggers causing inflammation in the lining of gastrointestinal tract, which directly, or indirectly, contributes to the clinical symptoms and complications.

Important risk factors shown to increase risk of IBD include:

Genetic predisposition. If someone’s family member is affected by IBD, there is increased risk of developing the inappropriate immune response. First-degree relatives have a 5 to 20-fold increased risk of developing IBD.

Smoking has shown to increase the risk for Crohn’s disease only and intensifies the risk.

Diet. The high intake of processed foods (especially fried food), animal fat and refined sugar increase the risk of developing IBD. Taking in high fruit content, which provides a source of dietary fiber, has shown to decrease the risk of Crohn’s disease. Obesity itself is not a recognized cause of developing IBD, but if someone is already diagnosed with IBD, obesity increases the risk of complications and alters the course of the disease. Obese patients are more likely to be hospitalized compared to non-obese patients.

A dysregulated immune response to the bacteria in the gut can also contribute to the pathogenesis of inflammatory bowel disease. Some studies have shown there is an association between acute gastroenteritis and development of inflammatory bowel disease.

Taking excessive or inappropriate antibiotics can possibly alter the gut flora and may increase risk for development of IBD.

Hormone replacement therapy and oral contraceptive usage has shown to increase the risk of developing ulcerative colitis. Studies have shown the longer the duration increases the risk of developing ulcerative colitis. Patients with known ulcerative colitis have shown improvement after discontinuation of hormone replacement therapy.

Signs and symptoms:
Patients with IBD have a wide variety symptoms and signs, with most symptoms common in both Crohn’s disease and ulcerative colitis.

Extended periods of diarrhoea with abdominal pain, sometimes with blood in the stools

Nausea and vomiting

Fatigue

Weight loss

Fever

Mouth sores and difficulty swallowing

Skin rashes

Joint pain

Eye problems, such as inflammation, redness, pain and blurriness

Perianal disease symptoms such as fissures and fistulas

These symptoms may occur in waves, can vary in severity and patients may be symptom-free for some time. If any of these symptoms occur, see a primary care physician for review and assessment. The provider will organize basic tests before referring to a gastroenterologist. The gastroenterologist may run a specialized blood test and endoscopy or colonoscopy depending upon the patient’s symptoms.

Treatment:
The goal of treatment is to keep patients in remission while preventing flare-ups and future complications. Most patients with IBD are treated with anti-inflammatory medication, steroids or more potent medications like immunomodulators and biologics.

Is there any cure?:
Crohn’s disease and ulcerative colitis are chronic conditions. Symptom control and remission can be achieved with medications, but a complete cure is difficult to achieve.

Tips for living with IBD:

Stress is not the cause of IBD itself, but living with the disease for both patients and their families can be overwhelming. Practicing psychological coping approaches like yoga, meditation, breathing exercises and participating in daily physical activities may help to reduce stress.

Patients and families should learn how to recognize flare-ups. Contact a healthcare provider immediately if needed.

Patients should follow up periodically with their healthcare provider to monitor symptoms, but also to identify current medications in order to avoid potential adverse effects.

The introduction of probiotics into the diet has shown some improvement in ulcerative colitis patients.

An increase in physical activity has shown to decrease the risk of Crohn’s disease.

All patients with IBD should have the required vaccinations in order to prevent infections.

Patients requiring frequent doses of steroids (if longer than three months) should discuss taking daily calcium supplements with their primary care provider. There is an increased risk osteopenia or osteoporosis (thinning of the bones), especially in postmenopausal women.

Patients with IBD should follow up with their gastroenterologist for periodic check-ups, as they are at increased risk of developing colorectal cancer and should be closely monitored.

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